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Cardiopulmonary > Stress Testing > Flashcards

Stress Testing Flashcards

1
Q

Low, Mod, High Risk

A

Low = asymptomatic who have less than or equal to 1 RF

Mod = asymptomatic who have greater than or equal to 2 RF’s

High = known CV, pulmonary, or metabolic disease w/ one or more symptoms

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2
Q

Signs/Symptoms that may put a patient at High risk for exercise testing

A
  • pain/discomfort in the chest, neck, jaw, arms or other areas that may result from ischemia
  • SOB at rest or with mild exertion
  • dizziness/syncope
  • ankle edema
  • palpitations or tachycardia
  • intermittent claudication
  • known heart murmur
  • unusual fatigue or SOB w/ usual activities
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3
Q

Risk Factors for Exercise Testing

A
  1. Age
  2. Family history
  3. Current cigarette smoker
  4. Obesity
  5. Sedentary lifestyle
  6. HTN
  7. Dyslipidemia
  8. Pre-diabetes
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4
Q

Types of stress testing (3)

A

Diagnostic for CAD, functional, and therapeutic

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5
Q

Diagnostic Stress Testing for CAD

A
  • symptom limited end-point - NO MEDS
    (EKG changes, SOB, chest pain)
  • will NOT reach exercise capacity
  • may do this type of test after placing a stent to determine effectiveness
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6
Q

Functional stress testing

A

WITH MEDS

  • monitor/ID CV response to exercise
  • low level GXT prior to discharge from hospital
  • comfortable walking speed & increase incline
  • stop at 4-6 METS or 75% of APMHR
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7
Q

Therapeutic Stress Testing

A

W/ or W/O MEDS

  • reason: optimize medical management
  • end-point may be a MET level equal to that of ADL’s
    (someone in very poor health)
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8
Q

Patient w/ CHF

  • Aerobic testing
  • end points
A

Cycle - ramp or staged protocol
Treadmill - Naughton protocol (peak performance often less than 5 METS)

End points: 
serious dysrhythmias
T-wave inversion w/ significant ST change
hypotensive
perceived SOB and fatigue
VO2 peak and ventilator threshold
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9
Q

CHF medications and effects on stress testing (5)

A
  1. Digoxin - diffuse ST effects, may improve performance
  2. Diuretics - may decrease BP
  3. Vasodilators - increase HR, decrease BP and improve performance
  4. ACE inhibitors - decrease BP, improve performance
  5. Antiarrythmias - may increase HR but little to no effect on performance
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10
Q

Aerobic exercise testing in MI patient

  • test
  • end points
A

Cycle - ramp or staged protocol
Treadmill - 1-2METS change every 3 min

End point:
serious dysrhythmias
>2mm ST segment depression or elevation
ischemic threshold
T wave inversion w/ significant ST change
SBP > 250 or DPB > 115
3+ on angina scale or higher
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11
Q

Exertional hypotension

A

suggest poor prognosis in patients with MI

drop of > 20 mmHg or failure to rise

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12
Q

Indicators of Adverse prognosis in stress testing w/ patients w/ MI

A

Ischemic ST segment depression at low level of exercise
Functional capacity less than 5 METS
Low peak RP
Hypotensive BP response to exercise

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13
Q

Blood lipid levels

A

Total - less than 200 is optimal, 200-239 is borderline, more than 240 is high

HDL should be greater than 40
LDL less than 100

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14
Q

Blood cell count

A

leukocytes increased may mean infection

Hemoglobin - low levels will stress the heart

  • females: 12-15.8
  • males: 13.3 to 16.2

Hematocrit (viscosity)

  • females 38-47%
  • males 35-44%
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15
Q

Coagulation Profile

- PT/PTT

A 
1 = normal
1.4 = 1.4x to clot ... etc

Thin blood means it will take longer to clot (PTT will be elevated)
- must monitor fall risk due to increased risk of bleeding to death

Thick blood means a shorter time to clot

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16
Q

BUN

A

blood urea nitrogen = BUN

Normal = 8-18 mg/dL

If elevated –> heart or renal failure, retention of urea
If decreased –> starvation, dehydration or organ dysfunction

17
Q

Creatine

A

measure of renal efficiency; as filtering function decreases, the creatine levels will increase

Normal 4.0 is renal insufficiency or failure

18
Q

Fasting serum glucose

A 
Normal = 70-100 mg/dL
Prediabetic = 100-125
Diabetic = >126
19
Q

Cardiac Markers (4)

A
  1. CK - creatine kinase
  2. troponins (gold standard = troponin I)
  3. Myoglobin
  4. LDH - lactate dehydrogenase
20
Q

Diagnostic tests for HR abnormalities

A

Holter monitor
12-lead EKG
exercise EKG

21
Q

Diagnostic tests for ischemia

A

EKG & exercise EKG
pharmacologic stress test
SPECT
Cardiac cath

22
Q

Diagnostic tests for valve integrity

A

echo
contrast echo
cardiac cath
PET

23
Q

Diagnostic tests for ventricular size & EF

A

chest x-ray
MUGA
echo

24
Q

Diagnostic tests for acute MI

A

cardiac markers/enzymes (blood test)

resting EKG

25
Q

Diagnostic tests for vascular system

A

ABI
Ultrasound
exercise studies

26
Q

SPECT

  • what is it
  • used for?
  • what will the results show
A

single photon emission computed tomography

Uses gamma rays to detect myocardial blood flow to examine for ischemia

Radionuclide perfursion testing for ischemia = Patient given radioactive agent at peak of stress test and then again 4 hours later to examine myocardial blood flow

  • If the “cold spot” or area of blockage is gone 4 hours later = ischemia
  • if it is still present then infarction (true dead spot, lost tissue)
27
Q

PET

  • what is it
  • used for?
A

positron emission tomography

radioactive tracer to assess blood flow while under the PET scan

  • used to examine valve integrity (stenosis)
  • increased radioactive material will accumulate in areas w/ high levels of chemical activity, which usually correspond to areas of disease
28
Q

MUGA

  • what is it
  • what is it used for
A

Multi-gated acquisition scan

non-invasive test to determine pumping function of the ventricles

  • radioactive tracer is injected and gamma camera detects radiation
  • HIGHLY accurate
29
Q

Echocardiogram

  • what is it
  • what is it used for
A

high frequency ultrasound that produces “real time” images of the heart

  • non-invasive way to look at function of the heart
  • including… size/function of ventricles, thickness of septum, function of walls, valves and chambers
30
Q

Cardiac Cath

A

cathedar feeded through femoral artery to coronary artery where dye is injected

  • evaluate narrowing/occlusion of arteries
  • measure BP in heart and O2 in blood

Cardiopulmonary (10 decks)

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